Mononucleosis Overview

The most common cause of mononucleosis is the Epstein-Barr virus, but other viruses also can cause similar symptoms. In fact, mononucleosis, or mono, can lead to a range of symptoms, including severe fatigue, fever, and a sore throat. However, symptoms typically generally resolve within around 2–4 weeks.

Mono is a common disease in young adults and teenagers. It most commonly develops with exposure to the Epstein-Barr virus (EBV).

Although there are no medical treatments for mono, a person can take steps to manage pain and relieve other symptoms.

Symptoms of Mononucleosis

Mono symptoms usually develop 4–6 weeks after exposure to EBV.

The time between exposure and symptoms first appearing is known as the incubation period.

Symptoms of mononucleosis can include:

These symptoms may not develop at the same time. Some people may experience severe symptoms, while others may have milder symptoms.

Fatigue

Mono can cause extreme fatigue, which can continue for a number of weeks and can affect a person’s quality of life long after some other symptoms have resolved.

A 2019 study of 65 people found that participants had some of the criteria of chronic fatigue syndrome in 40% of cases 6 months after the initial infection.

More studies are necessary to assess the long-term effects of fatigue after EBV infection and mono.

Sore Throat

People with mono often experience a severe sore throat. It may be worse than other types of sore throat.

Before the sore throat starts, the tonsils may produce discharge. Lesions might also appear on the roof of the mouth, although this is uncommon.

Fever

Mononucleosis often causes a fever. This can reach as high as 104ºF (40ºC).

The 2019 study mentioned above suggested that a fever this high may last for 2 weeks in people with severe mono, but temperatures of 101°F (38.3°C) can persist for up to 5 weeks.

Swollen Glands

Some doctors refer to mono as glandular fever, as it typically causes swelling in the lymph nodes, or glands.

A person may experience swollen glands in the neck or armpits.

Organ Swelling

Although less common than other symptoms, mono can cause swelling in the spleen and liver. Up to half of all people with mono develop a swollen spleen, or splenomegaly.

Livers or spleens that swell due to mono may remain swollen after other symptoms, such as fatigue, have resolved.

A person with mono needs to avoid sports, as any potential spleen enlargement may result in rupturing.

Other symptoms

Following are other symptoms that mono may cause:

  • Chills
  • Eye symptoms, especially pain and swelling around the eye and pain behind the eye
  • General feeling of being unwell
  • Muscle aches
  • Reduced appetite
  • Rash
  • Sweating
  • Yellowing of the whites of the eyes and the skin, known as jaundice

How long do Mononucleosis Symptoms Last?

Mononucleosis  symptoms resolve in 2–4 weeks for most people.

Different symptoms may resolve in different time frames:

  • Sore throat: This usually lasts 3–5 days before slowly starting to feel better.
  • Fever: A person’s body temperature may stay high for 10–14 days.
  • Fatigue: This commonly lasts for several weeks but may continue for months after other symptoms get better.
  • Swollen glands: These can last for a few months.

Some symptoms may last for at least 6 months in some people.

Causes of Mononucleosis

The most common cause of mononucleosis is the Epstein-Barr virus, but other viruses also can cause similar symptoms. This virus is spread through saliva, and you may catch it from kissing or from sharing food or drinks.

Although the symptoms of mononucleosis are uncomfortable, the infection resolves on its own without long-term effects. Most adults have been exposed to the Epstein-Barr virus and have built up antibodies. This means they’re immune and won’t get mononucleosis.

Complications of Mononucleosis

Complications of mononucleosis can sometimes be serious.

Enlargement of the Spleen

Mononucleosis may cause enlargement of the spleen. In extreme cases, your spleen may rupture, causing sharp, sudden pain in the left side of your upper abdomen. If such pain occurs, seek medical attention immediately — you may need surgery.

Enlarged Spleen

The spleen is a small organ usually about the size of your fist. But a number of conditions, including liver disease and some cancers, can cause your spleen to become enlarged.

Liver Problems

Issues with your liver also may occur:

  • Hepatitis. You may experience mild liver inflammation (hepatitis).
  • Jaundice. A yellowing of your skin and the whites of your eyes (jaundice) also occurs occasionally.

Less Common Complications

Mononucleosis can also result in less common complications, including:

  • Anemia — a decrease in red blood cells and in hemoglobin, an iron-rich protein in red blood cells
  • Thrombocytopenia — a low count of platelets, which are blood cells involved in clotting
  • Heart problems — an inflammation of the heart muscle (myocarditis)
  • Complications involving the nervous system — meningitis, encephalitis and Guillain-Barre syndrome
  • Swollen tonsils — which can block breathing

The Epstein-Barr virus can cause much more serious illness in people who have impaired immune systems. Patients with weakened immune systems may include people with HIV AIDS or patients taking drugs to suppress immunity after an organ transplant.

Prevention of Mononucleosis

Mononucleosis is spread through saliva. If you’re infected, you can help prevent spreading the virus to others by not kissing them and by not sharing food, dishes, glasses and utensils until several days after your fever has improved — and even longer, if possible. And remember to wash your hands regularly to prevent spread of the virus.

The Epstein-Barr virus may persist in your saliva for months after the infection. No vaccine exists to prevent mononucleosis.

Diagnosis of Mononucleosis

Physical Exam

Your doctor may suspect mononucleosis based on your signs and symptoms, how long they’ve lasted, and a physical exam. He or she will look for signs such as swollen lymph nodes, tonsils, liver or spleen, and consider how these signs relate to the symptoms you describe.

Blood Tests

  • Antibody tests. If there’s a need for additional confirmation, a monospot test may be done to check your blood for antibodies to the Epstein-Barr virus. This screening test gives results within a day. But it may not detect the infection during the first week of the illness. A different antibody test requires a longer result time, but can detect the disease even within the first week of symptoms.
  • White blood cell count. Your doctor may use other blood tests to look for an elevated number of white blood cells (lymphocytes) or abnormal-looking lymphocytes. These blood tests won’t confirm mononucleosis, but they may suggest it as a possibility.

Treatment of Mononucleosis

There’s no specific therapy available to treat infectious mononucleosis. Antibiotics don’t work against viral infections such as mono. Treatment mainly involves taking care of yourself, such as getting enough rest, eating a healthy diet and drinking plenty of fluids. You may take over-the-counter pain relievers to treat a fever or sore throat.

Medications

  • Treating secondary infections and other complications. A streptococcal (strep) infection sometimes goes along with the sore throat of mononucleosis. You may also develop a sinus infection or an infection of your tonsils (tonsillitis). If so, you may need treatment with antibiotics for these accompanying bacterial infections.

    Severe narrowing of your airway may be treated with corticosteroids.

  • Risk of rash with some medications. Amoxicillin and other antibiotics, including those made from penicillin, aren’t recommended for people with mononucleosis. In fact, some people with mononucleosis who take one of these drugs may develop a rash. The rash doesn’t necessarily mean that they’re allergic to the antibiotic, however. If needed, other antibiotics that are less likely to cause a rash are available to treat infections that may go along with mononucleosis.

Although there are no specific medical treatments for mono, a person can manage symptoms by:

  • Drinking enough fluids to stay hydrated, with small frequent sips if swallowing is too painful
  • Getting plenty of rest
  • using pain relief medications, including acetaminophen and ibuprofen

It is best to avoid intense physical activity, such as sports or lifting heavy objects.

 

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